• Nurse Case Manager Guidelines

    The Indiana Worker’s Compensation Board website contains guidelines regarding the role of a nurse case manager (NCM) in Indiana worker’s compensation cases.  If you use a NCM in the administration of a worker’s compensation claim, you should be sure that your NCM is aware of and is in compliance with these guidelines in the course of delivering NCM services to your injured employee.

    Qualifications:

    A NCM must hold a professional degree and credentials or be actively seeking credentials from an approved certification organization such as the Case Management Certification Commission (CMCC) or the Utilization Review Accreditation Commission (URAC).   An uncertified NCM must work under the supervision of a certified NCM. A NCM must follow the practice standards promulgated by the CMCC and the Case Management Society of America.

    Duties:

    The NCM is a liaison between the medical provider, the employer and the injured employee.  The NCM may facilitate the exchange of return to work information, treatment plans, medical needs (appointments, prescriptions, DME, tests, therapy, etc.) and expedite the scheduling and fulfillment of the attending physician’s orders.

    Communication:

    NCM discussions with the injured employee should be limited to the history, nature and extent of the injury; the medical treatment to be rendered and an explanation of such treatment, if requested; and the dates, times and locations for the such treatment. The NCM may be excluded from the examination of the injured employee by the attending physician.  If the NCM has a meeting with the attending physician at some place and time outside the examination room, then the employee must be invited to attend that meeting. Reports prepared by a NCM are not privileged and must be made available to the employee upon request.

    Decision Making:

    The NCM should not determine compensability, administer benefits, select or re-direct medical care or provide medical opinions to the injured employee or attending physician.  The NCM may be involved in discussions as to alternative treatment options, but the ultimate decision as to the course of treatment rests with the attending physician and the worker’s compensation board.

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